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r — - <br /> ORIGINAL STATE OF CALIFORNIA <br /> File with DWR THE RESOURCES AGENCY Do not fill it <br /> � ��� 4EPARTMENT OF WATER RESOURCES No. 083759 <br /> of Intent \o _ WATER WELL DRILLERS REPORT <br /> L rt Penntt No or Date Sttte Well No �} <br /> Other ti4ell No <br /> (1) OWNER <br /> NER2C3 Name Leon Jon,n„ <br /> Mari sQD a R d . (12) WELL LOG Tnr tI de 312 <br /> Irldresa pt1L`___ft Depth of completed welt L]-'2 ft <br /> OC trcim ft to ft Forrnjtlon (Describe by color chantter %vr <br /> crtv ton, a lf. z1p 9 205 - xZ8 In we nr materia) <br /> (� LG�Q�r01 {Ser Iilstrnctiiin.) - and W g seams O C <br /> l,ounty 3 and Y <br /> Owuers 11v ell Number — <br /> W ell address if different from -ahove — rown ^ <br /> Township R Inge <br /> Sectio an ay <br /> Dwtance farm cines Sam>V address <br /> roads rrilm�ds, fenees etc <br /> T *� <br /> (3) TYPE OF WORK <br /> New Well a Deepening <br /> Recniutrucrinn Q _ <br /> n <br /> Reconditioning Li <br /> Horizontal well <br /> t7Er.L[9 4~� Destruction ❑ <br /> I <br /> Ct destruction mzterials nals anti � <br /> procedures in Item I,Zk' ii installed on?aF%_ f/ <br /> (¢) PROPOSED U$�1� _ <br /> 1CL omestic <br /> 1 �i Irriglttnn � © � <br /> Industrial �� Q <br /> /` �J69�j r T�W ell \��� ❑ \ — - <br /> 1� tiluntcipol <br /> WELL LOCATION SKETCH Other r- ❑ <br /> (�7 EQLIPIIE`T (6) GRAVEL .PACK <br /> Rotary [] ReversI <br /> e ❑ _ <br /> ❑ \r><}� Size \ ` <br /> cihle <br /> Air ❑ L'ljitmeier of bore <br /> Other © Bucket ❑ )?`a.ck h'om lto,' {L..� <br /> L 7, CASING IhSTALLEi7 (g) -PERFORAT16;�*§ — <br /> ateel Yrasttc © C'nrkr ye s Type of perltj t- Dpi orVze of screen, <br /> Froin To Dia Ga�e dr P a\ V TO <br /> tt ft in Wall ft ft / ✓CSI - <br /> — <br /> .4^ <br /> (9) WELL SEAL - <br /> �%4b nurf LLL nanitdry seal pruvidedl Yes in NXn It ves tri depth ft — <br /> N4ere strata sealed against pollution;' Yes ❑ No <br /> Method of se-slin <br /> i 10) WATER LEVELS 4Vork started -------------- <br /> 19 Gnmplet 19 <br /> Deptdi of first eater if know NVELL DRILLERS STATEMENT 1 <br /> t : <br /> Sft <br /> tandinG letcl after Wellcainplrtui l.iw%le This well wan dnllvd under�tdtce and f ne irlrcirnn d thin ort ie trrri tr the ncsi up my <br /> tt Bglref <br /> f 11 ) WELL TESTS 1%L11 <br /> 1V1, c11 .est niidra SfGNEl3 <br /> Yes fl Vn � [t vey by whom? 7� -1 j..v <br /> il <br /> r7f of test Pump L5 Bailer ❑ Air lift 0 Parser RIe111-Mo lying; Inc . <br /> Ue c/ water at st NAZME lying;1 S <br /> rrt of test Et kt end of tis; <br /> ' ft 31 , E "�: LnUllt'ot 1-L' yUcLLL ntec}7 <br /> e gal,min Liter---------hours Nater tern Address <br /> pezatute <br /> G 1l tnulysis mai:10 Yes [j No ❑ If ve, by whom] Crty 7 9 a a e t a Z <br /> �4 t!1mtne Ioi, made yesP <br /> ❑ No ❑ If tics attach copy to this report License Na _ _ rhte of this re <br /> ,. ._ port__. <br /> DWR rae iREV 7 1e, IF ADDITIONAL SPACE IS NEEDED USE NEXT CONSECUTIVELY NUMBERED FORM <br />